Вы находитесь на странице: 1из 20

FINDING CURRENT BEST EVIDENCE

Dr. Retno Asti Werdhani Dept. Ilmu Kedokteran Komunitas FKUI

Knowledge Deteriorates in Time


knowledge of current best care

. ..
. . ....... .

r = -0.54 p<0.001

...

... ... .... .. ....

years since graduation

INTRODUCTION

Half of what you are taught will in 10 years have been shown to be wrong. And the trouble is, none of your teachers knows which half (Sydney Burwell, MD. Dean of Harvard Medical School, 1956) Keeping up to date with current best evidence for the care of our patients is challenging

INTRODUCTION
Best evidence resources are built according to an explicit process that values research according to its scientific merit and clinical relevance Search engine : electronic or pocket notebook Easy navigation from clinical question to evidence-based answers.

Where to find the best evidence?


(Traditional) textbook : - Useful for pathophysiology of clinical problems - Not to use for establishing the cause, diagnosis, prognosis, prevention or treatment of a disorder

Where to find the best evidence?

Textbook to be dependable in the modern era : Revised frequently (at least once a year) Heavily referenced (at least about diagnosis and management) Evidence in support Citation or web-linked textbooks is encouraging, but none of these provides systematically critically appraised evidence.

Invest in evidence databases

Evidence-based Medicine Review (EBMR) www.ovid.com Cochrane Library http://update.cochrane.co.uk

US National Library of Medicine http://www.ncbi.nlm.nih.gov/pubmed http://www.biomednet.com

Invest in evidence databases


-

Internal Medicine www.annals.org http://www.acponline.org Pediatric http://pedsccm.wustl.edu/EBJournal_cl ub.html Family Practice http://www.jfponline.com

Invest in evidence databases


-

http://bmj.bmjjournals.com/ http://content.nejm.org/ http://hiru.mcmaster.ca http://bmjupdates.mcmaster.ca/index.a sp www.freemedicaljournal.com http://www.guidelines.gov

How to control the evidence that finds you ?

Trade in your (traditional journal subscription Invest in evidence-based journals and online services ACP Journal Club summarize the best evidence from high-quality studies selected from all the journals of relevance to our clinical interest (general) Applicable clinical decision

Making answerable question


P I : Patient and/or Problem : Intervention

(C) : Comparation in intervention (if relevant)

O
(M)

: Outcome
: Methods

Whats the best evidence for each domain?

Therapy/Prevention Double blind randomized controlled trial Systematic review with meta-analysis; Prospective controlled study.
1.

2. Etiology/Cause/Harm RCTs or systematic reviews are the best study designs; Case-control studies are usually the best available; but sometimes a case study is the only evidence available.

Whats the best evidence for each domain?

3. Diagnosis Prospective cohort studies, with blind comparison to the gold standard
4. Prognosis Systematic review of homogeneous cohort studies Cohort study

Levels of Evidence
1. Systematic

review with meta-analysis of high quality randomized controlled trials with low heterogeneity. 2. Well-designed Randomized Controlled Trial (preferably double-blind) 3. Systematic review of observational studies. 4. Well-designed observational studies (prospective are considered to be stronger or less potentially biased than retrospective) 5. Unsystematic clinical reports: case study, case series 6. Authority, population studies, bench studies

Cases
Urinary Tract Disorders

A 35-year old woman sees you for a second episode of dysuria and fever. For the first episode 3 months ago, she was seen and treated by another GP with a course of co-trimoxazole for 7 days. She was well after that until the day before when the symptoms returned.

Cases
Hepatitis B Carrier Mr Tan is a 35-year-old engineer married with a 6 year-old son. He has been diagnosed as a Hepatitis B carrier 2 months ago while trying to donate blood. His son has had hepatitis immunization at birth. He has come to see you for advice.

Clinical problem

Define Important Searchable question Select most likely resource

Select second Most likely resource

Design search strategy

Design search strategy Poor Summarize The evidence

Summarize The evidence

Apply the evidence

Apply the evidence

SUMMARY

KEEP ON ASKING KEEP ON SEARCHING KEEP ON LEARNING

THAT WILL MAKE YOU A BETTERIMPROVED MEDICAL PRACTITIONER

Take Home Messages ??

THANK YOU

Вам также может понравиться